6
SPINE
SURGEONS
Lawsuits build against Aetna's spine
surgery coverage
By Alan Condon
A
nother lawsuit has been filed against
Aetna Life Insurance, arguing that
the insurer improperly limits cover-
age for lumbar artificial disc replacement by
treating the procedures as experimental and
investigational.
Six details:
1. Aetna uses a clinical policy bulletin — a
written directive on coverage positions
the insurer considers for certain medical
treatments — called "intervertebral disc
prostheses" when deciding claims for lumbar
ADR.
2. e insurer has "systematically denied all
requests" for lumbar ADR as "experimen-
tal and investigational" under the policy,
according to the lawsuit filed March 4 in the
U.S. District Court for the Central District of
California.
3. Contrary to Aetna's stance, lumbar ADR
was approved by the FDA more than 15
years ago and is considered a safe and effec-
tive procedure for lumbar disc disease.
4. Plaintiff Andrew Howard suffered from
disc disease at L5-S1 that caused significant
pain and mobility and conservative measures
such as medication and corrective exercises
did not provide adequate relief, according
to court documents. Robert Bray Jr., MD,
recommended Mr. Howard undergo lumbar
ADR, but Aetna denied the request and the
patient had to pay for the procedures out of
his own pocket.
5. e plaintiff argues that Aetna didn't cover
the spine procedure that should have been
covered under the Employee Retirement
Income Security Act, designed to provide
protections to as well as setting rules for em-
ployer-sponsored health insurance plans.
6. Aetna is also facing a 239-person class-ac-
tion suit from 2019 related to its alleged
denial of lumbar ADR. n
Spine surgeon owes $17M to
paralyzed patient
By Carly Behm
A
West Virginia man was awarded $17 million from a jury after
he was left paralyzed following spine surgery, Metro News
reported March 31.
Four things to know:
1. According to his 2019 lawsuit, Michael Rodgers was injured in a mo-
torcycle crash in 2017, and two days after the accident, neurosurgeon
John Orphanos, MD, ordered him to wear a back brace for six to eight
weeks. Later that day, Dr. Orphanos recommended surgery, according
to the lawsuit. Before the surgery, Mr. Rodgers had no neurological
deficits and could move all his extremities, according to the suit.
2. Dr. Orphanos didn't order testing to determine spinal cord issues
before the surgery, and he didn't know Mr. Rodgers had issues, includ-
ing spinal cord compression, spinal abnormality and injury. The lawsuit
alleges Dr. Orphanos went into surgery without plans to include de-
compression or use neurophysiological intraoperative monitoring.
3. After surgery, Mr. Rodgers lost motor function and sensation in
his lower extremities, the lawsuit states, and the issue persisted after
a second surgery. "He has been unable to use his lower body ever
since," according to the article.
4. A Kanawha County jury awarded Mr. Rodgers $17 million March
24, after an eight-day trial. The jury found that Dr. Orphanos was
"negligent and fully responsible" for Mr. Rodger's paralysis, accord-
ing to the report. n
How many
orthopedic surgeons
are in the US?
By Patsy Newitt
T
here are currently 22,965 orthopedic
surgeons in the US, according to data
firm Definitive Healthcare.
Definitive Healthcare tracks more than 2
million physicians. This data is accurate as of
February 2022.
Four stats to know:
1. California has the most active orthopedic
surgeons in the U.S. at 2,406.
2. There has been a gradual increase in ortho-
pedic surgeons over the last six years, with a
slight decline from 23,063 in 2020 to 22,965
in 2021.
3. From 2016-21, the number of orthopedic
surgeons jumped 6 percent, from 21,617 to
22,965.
4. Nearly 1 million knee and hip arthroplasties
were performed in 2021. n
